Hypertension is a widespread global health problem. It has been the main cause of morbidity and mortality. With the concept of disease transition in Africa, we are moving from an era of communicable diseases to an era of non-communicable diseases such as Hypertension. In sub-Saharan Africa (SSA), patients with hypertension frequently present late to health facility often with complications. Moreover, the fact that hypertension is asymptomatic, patients tend to have poor adherence to medications which results to uncontrolled hypertension. Uncontrolled hypertension will eventually result into progressive damage to target organs such has the heart and kidneys. Chronic elevation of blood pressure (BP) leads to progressive development of left ventricular hypertrophy (LVH) with consequent cardiac remodelling, heart failure (HF) and increased risk of cardiovascular events. The burden of LVH together with the factors associated with its progression has not been well studied. This study aimed to investigate the prevalence, pattern and associated factors for LVH among patients attending MMH Zanzibar. In this current study we found among 389 hypertensive patients 241 (62%) patients had abnormal LV geometry, 55% had concentric hypertrophy. We also found sex, employment, domicile, duration of hypertension, BMI, and urea levels were having the positive value predictors of LVH.